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Inspection on 29/06/05 for Brightbow Lodge & Brightbow Court

Also see our care home review for Brightbow Lodge & Brightbow Court for more information

This inspection was carried out on 29th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The residents benefit from staff who involve them in planning their own care and respect residents as individuals. Residents in this home can exercise choice and the activities organiser offers a wide range of activities for residents to participate both in and out of the home. The residents are encouraged to participate in community activities.

What has improved since the last inspection?

The residents are protected by improvements made to the recruitment information collected from new staff, which helps ensure staff are fit to work in the home.

What the care home could do better:

The residents would benefit from improvements made to the home`s environment, maintenance and new furniture. The residents would benefit from having the offensive odour in the entrance hall into Brightbow Lodge being identified and removed. Some of the care information in Brightbow Court needs to be updated to ensure residents receive the more appropriate care from staff. More staff attending the protection of vulnerable adult training would better protect residents. Resident`s safety would be improved if the care risk assessments were up to date and more detailed. The residents would receive a more varied diet after the menus get reviewed.

CARE HOME ADULTS 18-65 Brightbow Lodge & Brightbow Court 11-16 Philip Street Bedminster Bristol BS3 4EA Lead Inspector Savio Toson Unannounced 29 June & 1 July 2005 09.30 th st The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 3 SERVICE INFORMATION Name of service Brightbow Lodge & Brightbow Court Address 11-16 Philip Street Bedminster Bristol BS3 4EA 0117 9636409 0117 9464470 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Lodge Rest Limited Ms Angela Sankey Care Home with nursing 57 Category(ies) of MD Mental Disorder (57) registration, with number of places Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 57 persons aged 18 - 64 years with mental disorder requiring nursing care excluding persons detained under the Mental Health Act 1983. May accommodate up to 19 persons aged 18 - 64 years with mental disorder requiring personal care excluding persons detained under the Mental Health Act 1983. Manager must be a RN on parts 3 or 13 of the NMC Register. Staffing notice dated 28/4/1994 applies. May accommodate up to 10 people aged 65 years and over with mental disorder requiring nursing and/or personal care within the existing registered numbers, excluding persons detained under the Mental Health Act 1983. Date of last inspection 10 March 2005 Brief Description of the Service: Brightbow Lodge and Court are located in Bedminster, close to the city centre, within walking distances of local shops and amenities. Main bus routes and bus stops are close by. The homes offer 24 hour social and nursing care, and are able to meet a range of needs providing active rehabilitation, low level rehabilitation and continuing care. The home has an activities organiser to work with individuals, develop activity programmes which have an emphasis towards social, recreational, educational or employment skills training. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the inspection the serious incidents and accident reports sent to this office by the Brightbow homes were reviewed along with the previous inspection report. The unannounced inspection took place over two days. The inspector spoke with 18 residents to collect their views and experiences of living in the home; spoke with 6 staff; walked around the home and looked at the relevant documentation. Most of the residents who met the inspector demonstrated they could represent their own views and provided a valuable description of life in the home. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,4,5. Residents benefit from a fully comprehensive assessment being carried out by the home to help ensure their care needs will be met when they move into the home. Residents benefit from clearly set out agreements of accommodation. EVIDENCE: A recent admission into the home demonstrated that the admission process was designed around the pace set by the potential resident. This included several visits to their previous home and current home with support from a number of staff. Several agreements of accommodation which set out the terms and conditions for living in the home contained the required recommendation and had been signed by both the resident and the home’s representative. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9. Residents in The Lodge know their care needs are represented in their care plan whilst those in The Court may be receiving outdated care. Residents were not receiving sufficient protection against potential risks to their well-being. Residents are assisted in making choices and supported in maintaining an independent life style. EVIDENCE: The care plans viewed in Brightbow Lodge were up to date, contained a range of relevant information and were reviewed regularly. Some of the records in Brightbow Court were not being reviewed regularly enough which means that changes in care needs were not being identified. Records in both houses contained a range of information to help staff support the resident to meet their care needs, contained risk assessments and several plans contained the residents signature which demonstrated their meaningful involvement in planning their care. The residents benefited from staff who could write care plans which encouraged residents to maintain their independence and take responsibility for their lives. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 9 The risk assessments in Brightbow Court were limited in detail and needed to be further developed. The residents could describe their independence: “I’ve moved into a different bedroom and I’m starting to go out more”; “I go and work in horticulture” and another said “I am helping other residents in developing their computer skills.” Another resident said, “I go out regularly and today decided to go to the pub for one drink only”. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,13,14,15,16,17. Residents are able to express their views which are taken seriously. The Residents’ skills and sociability are developed by the home offering a range of activities and community involvement. Resident’s rights are respected. Residents may be getting tired of one week of menus which does not provide enough variety of meals. EVIDENCE: The home holds resident’s meetings which enables them to express their views and the inspector read a copy of the minutes from the most recent meeting. The home has an activities room which contains examples of some of the work produced by residents during their arts and crafts sessions. The home has an activities organiser who has introduced a range of activities into the home which include computer training, discussion groups, musical activities, exercise, and darts. The activities timetable is changed weekly and the organiser is involved in developing community links for residents with voluntary agencies and placements in training centres. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 11 The home has access to transport so that residents go out on a weekly basis. Residents who do not access the organised activities receive individual sessions from the activities organiser who also leaves suggestions on the activities which can take place when she is not on duty. One resident explained how he was involved in helping to train other residents in computer skills. The inspector thought the organiser’s plan to develop transferable skills in residents was good practice. The residents views of the meals varied, but the majority said they enjoyed the meals served, they could exercise choice and select alternatives to the meal offered. The inspector viewed two weeks of menus and noted that week two contained a chicken meal on at least four occasions, also the cooked breakfast scheduled for twice a week was not a full English breakfast as stated on the menu. Discussions with the chef on duty reflected the staff willingness to adjust the service to meet residents needs. Week two menu was going to be reviewed and a full English breakfast would be provided to those who requested it. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20. Residents receive the physical and emotional support they require. EVIDENCE: The inspector noted one resident being assisted to mobilise by two visiting physiotherapists. The residents were telling the inspector about regular visits from the new psychiatrist and the records showed that the general practitioner and social workers were in regular contact with the home. The medicine administration sheets viewed by the inspector met the requirements. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23. Residents in this home have their views heard, but the more vulnerable resident would be better protected by staff who have received training in protection of vulnerable adults from abuse. EVIDENCE: The home has the complaints procedure on display and a procedure is given to residents to read and sign when they are admitted into the home. The complaints received by the home are low and the few viewed by the inspector showed that they were taken seriously and dealt with efficiently. A recent incident demonstrated that some of the staff were unclear about the process for implementing the protection of vulnerable adults procedure, however the inspector noted that a training session had been arranged for staff to attend. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,30. The premises could be more homely and comfortable for residents. Residents can express their individuality by the way they arrange their bedrooms. EVIDENCE: The home takes a lot of wear and tear from a very active group of residents which means that some carpets, furnishings, walls and paintwork are damaged and need replacing. On the whole the home was found to be kept clean and tidy; however, there is quite an offensive smell in the Brightbow Lodge entrance hall which needs to be identified and dealt with. The resident’s bedrooms varied according to individual taste and the inspector noted staff moving furniture around to help accommodate a resident’s recent purchase of additional furniture. This was seen as another example of where staff are working for the residents. The communal areas were starting to look tired and dull. The inspector found them dark and suggests that consideration is given to them being redecorated to brighten them up. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34,35,36. Residents benefit from staff who are competent, receive training and are recruited by the home’s competent recruitment practices. EVIDENCE: All the residents who were asked by the inspector, spoke well of the day staff and how they found them helpful and supportive. As one resident said, “the staff are very good; I get on with them alright”. The home manager was able to describe how the training programme had slowed down, but training for staff was still taking place. The inspector viewed three personnel files of recently recruited staff and noted they contained the information which was required by the regulations. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,41,42. The residents live in a well maintained environment but safety was compromised by the homes security arrangements. EVIDENCE: The fridge and freezer temps were being recorded daily by the kitchen staff. The five yearly electrical installation check was being carried out by electricians on the first day of inspection. The fire precautions in the Court were up to date whilst the fire log book in the Lodge was not available because it was locked away; however the owner supplied the required information within a few days. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 17 The fire door leading into Brightbow Lodge’s main lounge was open and the inspector walked straight in; also the fire escape door on the ground floor was alarmed, but the alarm did not work when tested. With both these arrangements the residents were at risk of theft or confrontation from uninvited visitors to the home. The Registration certificate was up to date and so was the employers liability insurance. Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 2 x 2 Standard No 11 12 13 14 15 16 17 3 3 3 x 3 N/A 2 Standard No 31 32 33 34 35 36 Score x 3 3 3 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Brightbow Lodge & Brightbow Court Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x 3 2 x Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. 5. Standard 24 30 6 9 42 Regulation 23(2)(b) 16(2)(k) 15(2)(b) 13(4)( c ) 13(4)(a) Requirement Rooms in the home where walls are scratched and marked need to be redecorated the odour in Brightbow Lodge needs to be identified and removed. the care documentation in Brightbow court needs to be reviewed and updated. the risk assessments in Brightbow court need to be more detailed and updated the exits into the street need to be reviewed to ensure the maintainance of residents safety. Timescale for action 1 Oct 05 1 Aug 05 1 Sept 05 1 Sept 05 1 Sept 05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 17 Good Practice Recommendations the menus need to be reviewed to ensure a more balanced diet and that where the menus state a full english breakfast, one is provided. (This does not need to be a requirement due to the positive response from the chef.) Brightbow Lodge & Brightbow Court Version 1.30 D56_20271_Brightbow_233571_290605_Stage4.doc Page 20 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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